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00:00In just a few years, Ozempic has become a household name and a cultural phenomenon.
00:05GLP-1 drugs are everywhere, and already one in eight U.S. adults have tried them.
00:10The Danish company that makes Ozempic is worth more than the Coca-Cola company and McDonald's combined.
00:16Look online, and you'll see comments about Ozempic face, hair loss, severe stomach problems, and dangerous side effects.
00:22And then a moment later, you'll see a report that it could help with fertility, or treating Alzheimer's, or even shopping addiction.
00:28And it's not just weight loss drugs. We've been lied to about weight loss itself, for years now.
00:33How much do we know about GLP-1 drugs, and are we being told the full truth about them?
00:37I've spent the last few months diving into the research, and even tried to get some GLP-1 medication myself to see what's really going on here.
00:46At this point, I've spent a lot of time on social media, digesting what the discourse is out there about this medication.
00:52One of the pieces of misinformation I'm seeing over and over again is this idea that these drugs are brand new,
00:57that they're not well studied, and that they're not well understood.
01:00It's not studied for this. You know, there's no studies on what it does to a body without diabetes.
01:06There is no research, no research, on a person that is not diagnosed with type 2 diabetes.
01:12So we know that this line, that they are untested or not understood, is just not true.
01:16They've been studied a lot for both safety and efficacy, for both diabetes and weight loss.
01:22Thousands of people have been studied in clinical trials specifically for obesity, but not for diabetes.
01:27The new phenomenon is that ozempic is a household name, and it became a household name because of its weight loss effects.
01:32However, it's part of a class of drugs that have been used for decades to help people with type 2 diabetes regulate their blood sugar.
01:38And just in that regard, it's been a huge medical breakthrough.
01:41I think we could probably critique that on its own, in that our society is so weight-obsessed
01:46that none of these diabetes treatments were a household name, even though a million and a half people die of it each year.
01:51But as soon as it started making celebrities skinny, all of us were talking about it.
01:55That's probably worth unpacking, but that's more than we will have time to do here.
01:59So when Novo Nordisk started testing these drugs as an obesity treatment,
02:03the outcome of those trials suggested that these are the most effective weight loss drugs ever.
02:08So the main ingredient in ozempic is semaglutide.
02:10It's part of a class of drugs called GLP-1 receptor agonists,
02:14which basically just means they mimic a hormone that naturally occurs in your body called GLP-1.
02:18Semaglutide is in both ozempic and Wegovy.
02:21But Wegovy is the one that's FDA-approved for weight loss.
02:24If these medications are paired with a healthy diet and exercise,
02:28people who are on semaglutide lost on average 15% of their body weight.
02:31The people who were just dieting and exercising lost on average 2.4% of their body weight.
02:36A newer drug made by Eli Lilly called terzepatide did even better in its clinical trials,
02:41with people losing an average of 20% of their body weight.
02:44And so based on that data, we started to have all this very hyped news coverage
02:49about how these drugs were a game-changer and a blockbuster,
02:52and how maybe obesity would be cured forever,
02:55which honestly is kind of a bizarre framing.
02:58Even from the very first studies, there were people who were not responding to these drugs.
03:03Yes, it's a really big deal that 86% of people in a trial lost a significant amount of weight.
03:08However, that means 14% of people didn't.
03:13Despite all this talk about miracle drugs,
03:16the figures are basically the same for both semaglutide and terzepatide.
03:19Roughly 1 in 10 people don't lose significant weight while on this medication
03:23and are what's called non-responders.
03:25I really wanted to speak to someone who went through this,
03:27so I put a survey up on BI's social media channels, and that's how I found Erica.
03:31It's working for other people, like why isn't it working for me and my body chemistry?
03:36But I'm mad it didn't work, but then I accept it,
03:39and I just gotta find another way to lose the weight.
03:42Erica says her doctor didn't warn her that these drugs don't work for everybody.
03:46Like many of us, most of her information came mainly from media coverage.
03:50When you set these drugs up as a miracle or a magic pill,
03:53you're also setting people up for massive disappointment
03:56if they had high hopes of weight loss and then these drugs don't work for them.
03:59There is one more thing that a lot of coverage has missed.
04:02Real life is not the same as a clinical trial.
04:05Since those first trials and all that news coverage,
04:07there's been more data about what real world usage looks like.
04:10A 2023 study followed people on senuglutide for 52 weeks,
04:14and those people lost an average of 4.4% of their body weight.
04:18So we went from 15% down to 4%, which is a dramatic difference.
04:22Most of the early coverage of these drugs used the numbers from the clinical trials,
04:26which makes sense because it was the first time these drugs were studied.
04:29The subsequent real world usage impacts have not gotten as much press coverage.
04:33And that definitely feeds into an inflated sense of how revolutionary these drugs could be.
04:38Certainly, they are a really big deal. They're more effective than prior drugs.
04:41But there are limitations.
04:43The other thing that I think might be getting lost here is that
04:46weight loss from these drugs will have a plateau,
04:48which is similar to diet, to exercise, and even to bariatric surgery.
04:52At some point, every weight loss intervention plateaus.
04:55There's this popular conception that losing weight is the hard part
04:59and maintaining weight loss should be easy.
05:02What we know is that it's actually the opposite, right?
05:05The maintenance of weight loss is actually the hardest part.
05:08You wouldn't want a drug that allows you to lose unlimited amounts of weight.
05:11That would be dangerous for one,
05:13and then you'd have to go off of it when you reached your goal weight,
05:16and then you would just start to climb back up again, and it would be this constant yo-yo.
05:19However, that doesn't stop people from talking about this plateau like it's some sort of
05:23betrayal of the drug or some sort of failure of this medication.
05:27All evidence points to needing to keep taking these drugs to keep benefiting from them,
05:31which is interesting because we have study data showing that most people don't keep taking them.
05:35One study looked at thousands of people with GLP-1 prescriptions
05:38and found that about half of them stopped taking it after a year,
05:41and 70% of them stopped taking it at the two-year mark.
05:44And another study found that after stopping the medication,
05:47people regained on average two-thirds of the weight that they'd lost.
05:50This is perhaps another big reason to dial down the hype machine on these medications.
05:55Yes, they are a big breakthrough medically,
05:57but if people don't want to be on them,
05:59then the impact of the drugs will be much lower than were predicted
06:02in the flurry of news coverage we had to begin with.
06:05A lot of people hear that this is a long-term, potentially lifelong medication,
06:09and they see Big Pharma dollar signs.
06:12The cynic in all of us sort of wakes up and says,
06:14what a win for Big Pharma.
06:15It's true that it is a win for Big Pharma.
06:17They're probably going to make a ton of money on this,
06:20and there is absolutely no denying that.
06:24I understand why people are mistrusting of pharmaceutical companies
06:27and the media coverage around them.
06:29At this point, we've seen some very irresponsible reporting.
06:32I think it's really important to be clear-eyed
06:34about the role of big pharmaceutical companies in our society.
06:37With just a quick Google, you can see that Novo Nordisk has paid fines
06:41after being accused of shady sales tactics,
06:43they've faced criticism for spending loads of money whining and dining doctors,
06:47and that they've gotten in trouble with regulators in multiple countries.
06:50More famously, Novo Nordisk, along with other drug makers,
06:52faced massive criticism for high insulin prices.
06:56Nowadays, insulin is less profitable than it once was.
06:59But the potential profits of weight loss drugs remain astronomical.
07:03And make no mistake, Novo Nordisk will be cashing in on these drugs,
07:06and already is.
07:07At one point, the company's valuation was bigger than the entire GDP of Denmark.
07:11Understandably, some people who don't trust Big Pharma
07:14or simply don't have access to these drugs
07:16are turning to natural alternatives.
07:18Let's talk a little bit more about nature's ozempic.
07:22Nature's ozempic.
07:23Nature's ozempic.
07:24Nature's ozempic.
07:25Nature's ozempic.
07:26You'll find people presenting berberine, peppermint tea, green tea,
07:30vitamin B12, high-fiber diets, high-protein diets,
07:33all of these things as being natural alternatives to taking ozempic.
07:37There are certain foods that can increase the amount of GLP-1 hormone that your body makes.
07:42The part where they get it wrong is that that doesn't necessarily equate to weight loss,
07:46which appears to be the goal of many people consuming this content.
07:49The level of GLP-1 production that diets can provide
07:52is nowhere near what you can achieve with prescription medications.
07:55These interventions are leading to supraphysiological levels of GLP-1
08:01as opposed to modest changes in your diet or some supplement that you could take.
08:06These are just orders of magnitude different,
08:10and you're not going to see anywhere near the same effect.
08:13But between influencer nutritionists and supplement grifters,
08:16we're seeing tremendous amounts of misinformation online
08:19about how effective a GLP-1-boosting diet can be.
08:22These foods and vitamins are generally less risky than a serious prescription drug,
08:26but they're almost definitely less effective as well.
08:32This is another subject of intensive news coverage
08:35where I think we just need to turn the hype dial down a little bit
08:38and look at what the research actually tells us.
08:40I also think people pay a lot of attention to side effects of these drugs
08:43because we've had plenty of examples of prescription drugs coming onto the market,
08:47and a side effect no one knew about ends up being very serious,
08:49particularly for weight loss drugs.
08:51The most common side effects of these medications are gastrointestinal,
08:55things like nausea, vomiting, and diarrhea.
08:57These can seem a little bit trivial, just like tummy trouble or whatever,
09:00but they can be quite serious.
09:02Extended periods of vomiting or diarrhea can leave you dangerously dehydrated.
09:06It's even been reported that one woman died while taking these drugs
09:09after months of gastrointestinal issues,
09:11including severe vomiting and abdominal pain.
09:13Besides the GI issues, the FDA label for these drugs includes a number of other warnings,
09:18some of which are for very serious conditions.
09:20So if we just pull up the label now,
09:22there's what's called a black box warning about the risk of thyroid c-cell tumors.
09:26The warning label mentions findings in rodents,
09:29but a GLP-1 researcher I spoke to said that the thyroid in rodents and humans is quite different,
09:34so those findings probably aren't relevant.
09:36Sometimes by putting a warning label on because of initial good intentions,
09:41you can cause more harm by scaring away people
09:44who otherwise might be willing to take this medicine and benefit from the medicine.
09:50While the link between GLP-1 medication and thyroid cancer has been hard to establish,
09:54the link between obesity and thyroid cancer is much clearer.
09:58One study found that for every 5-point increase in BMI,
10:01the risk of thyroid cancer increases by 30%.
10:04There's also another category on this label called warnings and precautions,
10:07and it includes acute pancreatitis, acute gallbladder disease, hypoglycemia, acute kidney injury,
10:13hypersensitivity reactions, diabetic retinopathy, heart rate increase, and suicidal behavior and ideation.
10:19The label here just says monitor for depression or suicidal thoughts,
10:22discontinue Wegovy if symptoms develop.
10:26That's not very reassuring to me.
10:28This is an ongoing and evolving thing,
10:30but the weight of evidence so far suggests that these drugs alone
10:33are not going to cause you to have suicidal thoughts.
10:36It is not uncommon for drugs to have very intimidating,
10:39if not downright scary-looking FDA warning labels.
10:42It's important to remember that things listed on these labels are potential risks
10:45rather than guaranteed results,
10:47which actually does seem to get lost in the shuffle a bit on social media.
10:50Most of the more serious side effects of GLP-1 drugs are on the rare side.
10:54Most people who take these medications will not get pancreatitis.
10:57Sometimes people wonder why a drug could be approved if it has so many alarming side effects.
11:01But it's really not uncommon.
11:03If you look at metformin, a very popular diabetes medication,
11:06it has a warning for potentially fatal lactic acidosis.
11:09If you look at the label for ibuprofen,
11:12it has a warning about potential increased risk of stroke.
11:15These things are calculated in the context of being sick.
11:18If you take these drugs and don't have a medical need for them,
11:20your risk calculation is different,
11:22and you are putting yourself at greater risk of harm.
11:24Your neighbor who is interested in taking this medicine to lose 10 pounds
11:30before they can get into a size 8 dress for Uncle Harry's wedding,
11:34they weren't studied in a clinical trial.
11:36But besides what's on the label, which is scary enough on its own,
11:39there's all these rumors on social media about a whole other category of effects
11:43that are mostly cosmetic, things like ozempic face or hair loss.
11:47And it's not just hair loss.
11:49There's been a ton of concern about how much muscle people lose while taking GLP-1 drugs.
11:53However, whenever you lose weight,
11:55even if it's just through diet and exercise,
11:57you do tend to lose some lean muscle.
11:59One thing that's often forgotten in this whole conversation
12:01is that weight loss itself can have some very serious side effects,
12:04particularly rapid or extreme weight loss.
12:07Even losing weight fast through diet has been linked to hair loss,
12:10muscle loss, depression, gallstones,
12:13all side effects that overlap with the side effects of ozempic.
12:16So it's really hard to tell where one ends and the other begins.
12:19Personally, I think this is just another example
12:21of how the conversation around ozempic has just gotten really weird.
12:25People seem to want there to be a punishment for taking a vanity drug,
12:28and almost gleefully report this idea that your face or your hair or whatever
12:32would fail you when you've taken a step to make your body look nicer.
12:36At least that's the perception.
12:38And to be sure, some people have taken ozempic as a vanity drug.
12:41These drugs became a household name
12:43because celebrities were touting them for weight loss,
12:45and in many cases, already thin celebrities were touting their weight loss benefits.
12:49So we've talked about the bad,
12:51but there are also some really interesting positive effects
12:53that these drugs potentially have.
12:56Not only do they make you crave less food,
12:58they make you desire different, usually healthier food.
13:01There's a physiological response that causes some people
13:04to be more preoccupied with food than others.
13:07People I talk to who have been suffering from food noise say
13:12the drug feels like a switch is being flipped in their brains.
13:15People have now reported other cravings going away too,
13:17like the urge to online shop.
13:19These drugs could help with all kinds of conditions,
13:22Alzheimer's, Parkinson's, alcohol addiction,
13:24and other types of addiction, depression.
13:26There's even anecdotal reports of ozempic babies,
13:29which are people whose fertility improved while they were on these drugs.
13:33All these things aren't so much side effects
13:35as they are potentially brand new indications for the drugs,
13:38brand new conditions that they could treat.
13:40GLP-1 drugs have a really unusually high number of potential new indications.
13:45About 1 in 8 Americans have already tried GLP-1 medications,
13:49and this explosion of interest has led to something we've never quite seen before.
13:54One of the strangest elements of this rush for everyone to try semaglutide
13:59is that it put the drug in shortage.
14:01And when drugs are on the official FDA shortage list,
14:04compounding pharmacies can make their own versions.
14:07Compounded versions of these drugs are not FDA-approved or reviewed.
14:10And because these pharmacies are regulated at the state level,
14:13there's no data available for how many people are taking compounded GLP-1s.
14:17In an environment this confusing,
14:19it becomes easier to take advantage of people.
14:22I spoke to a researcher who purposefully ordered
14:24compounded semaglutide from shady online sellers
14:27just to see what he would get.
14:29We looked at the online pharmacies that were no prescription
14:33and were highest ranked in search results.
14:36So these were some of the websites that consumers will see first.
14:40Of the six drugs that he ordered, three never came at all.
14:43They were total scams.
14:44So they took the three prescriptions that they actually received
14:47and put the drugs to the test.
14:48And what they found was evidence of contamination
14:51and improper amounts of the active ingredient semaglutide.
14:54The FDA has also issued a warning about some compounders using semaglutide salt,
14:58which is generally used only for research
15:00and is not approved for use in humans.
15:03So for consumers, the most important thing is to understand
15:06that when you source it from a no-prescription online pharmacy,
15:09there's a lot of risks.
15:10Either fraud, incorrect product,
15:13or, again, you're not getting a product that is medically necessary for you
15:16or appropriate for you.
15:18Offering no-prescription versions of prescription drugs is illegal.
15:22But there's also what feels like a tidal wave of buzzy online health startups
15:25who can temporarily sell compounded semaglutide totally legally.
15:29I actually went through the process of being prescribed compounded semaglutide.
15:33I went through an online pharmacy where all I had to do was fill out a survey
15:36and then do a video telehealth visit with a doctor to be prescribed these drugs.
15:41I went through this process for reporting purposes
15:43to see how easy it would be to get these drugs.
15:45And it turns out, it was pretty easy.
15:47Which, depending how much you value drug regulation, could be kind of concerning.
15:51There was sort of no question that I was going to get these drugs.
15:54From the second the call started, it was a given.
15:56I don't know why, but I thought he might challenge me and say like,
15:59ah, these are some pretty heavy-duty side effects.
16:01Are you sure you want to take these drugs to lose a small amount of weight?
16:05But he didn't.
16:06And the doctor that I spoke to in that process
16:08did not give any indication that I would need to stay on these drugs
16:11to maintain the weight loss.
16:13I'm not saying all this to fearmonger about compounding pharmacies,
16:16but it is kind of wild how little we know
16:18about how many people are taking drugs from compounding pharmacies
16:21when we do know that they come with a higher degree of risk.
16:24However, there is one considerable upside,
16:26and that's that for some people,
16:27compounding pharmacies offer a cheaper version of these drugs.
16:30In my case, a month's supply of semaglutide cost $250.
16:35The list price for Ozempic in the United States
16:38is almost $1,000 for a month's supply.
16:41For Rigovi, it's $1,349.
16:45Those are shocking price tags.
16:47You can find economists estimating that GLP-1 medications
16:50will add $1 trillion in health care spending to the U.S.
16:54Then we have other economists estimating
16:56that it's actually somewhere between 20% and 50% of that.
16:59And it's not really possible to know who's right or wrong
17:02because the actual prices paid to drug makers are secret.
17:05And that's one of the many oddities of the American health care system
17:08is that no one knows exactly what drug makers actually make
17:11from selling their drugs.
17:12It's considered proprietary information.
17:14At the end of the day, a lot of people seem to want it to be true
17:17that these drugs could actually save health care systems money,
17:20that we spend so much on treating obesity and related conditions
17:23that these drugs could actually be a net money saver.
17:25And while that might eventually happen,
17:27especially if the cost of these drugs goes down,
17:29that is a very rare feat for a drug to pull off.
17:31The most important thing to remember is that if you see estimates
17:34of how much a certain drug is going to cost U.S. health care systems
17:37or how much obesity costs America in general,
17:40remember that these are really rough estimates.
17:42And that's important because the stigma that people with obesity face
17:45is often couched in this idea that they're a tremendous financial burden
17:48to the health care system.
17:52I have seen countless comments saying,
17:54why do you need Ozempic if you can just eat healthier?
17:56Why do you need to take these drugs?
17:58What you're looking for is willpower.
18:00It simply doesn't make sense to talk about Ozempic as being the easy way out.
18:03The easy way out implies there's another way out.
18:06And for a lot of people, there just isn't.
18:08What these medicines have taught us is that a huge number of people
18:13living with obesity, they were restricting their calories.
18:17They were following diets.
18:19They were exercising.
18:21And it just didn't work for them,
18:24even though they really wanted it to work.
18:27And now we have something that helps them.
18:30And guess what?
18:32They're losing weight.
18:34We've been lied to about weight loss for a long time.
18:37And we're only just starting to figure it out.
18:39The reality is that we, both as a culture and the medical community,
18:44have been significantly underplaying how difficult it is to lose weight
18:48and especially how difficult it is to maintain weight loss.
18:51We have a ton of data on this at this point.
18:54And we know that drastic weight loss is exceedingly rare
18:56and is usually temporary.
18:58Over time, we've also learned that exercise
19:00is not nearly as big of a factor in weight loss as people tend to suggest.
19:04It has many benefits and is still important for overall health.
19:07But burning more calories is not a guaranteed path to weight loss.
19:11Many studies have shown at this point that even in the best of circumstances,
19:14where we're combining diet, exercise, and behavioral counseling,
19:18people tend to only lose 5% to 10% of their body weight.
19:22Then after that, your body fights back.
19:24When you lose weight, your body starts to release hormones
19:27that increase appetite and reduce feelings of fullness.
19:30So there's actually a biological mechanism encouraging people to eat more,
19:33as weight is lost.
19:35Studies on people who've lost quite a lot of weight
19:37have found that they burn fewer calories than scientists expected,
19:40even when you account for the fact that their bodies are smaller
19:42and they're carrying less weight around.
19:44If you lose, you know, roughly 20 pounds or so,
19:48and you're maintaining that 20-pound weight loss,
19:50you're probably burning about 250 calories per day
19:53less than you were before you lost the weight.
19:55And we've known that for a very long time.
19:58The advice that doctors gave for years
20:00was that all it takes is small tweaks to your lifestyle.
20:03Swap your bag of chips for an apple or take the stairs.
20:06You can still find all kinds of advice like that online.
20:09And it's actually, frankly, bizarre that after decades of research
20:12supporting the idea that this is a very complex issue,
20:15so many people insist on acting like it's easy.
20:18It is understandable to have anxiety about medicating millions of people
20:21for what's seen as a wider societal issue.
20:24And some people say this is a Band-Aid on a bigger problem,
20:27those bigger problems being things like our food system
20:30or our sedentary lifestyles.
20:32And yes, there would likely be tremendous social benefit
20:35to addressing those very complex systemic problems.
20:38But for now, we have a relatively safe and effective drug
20:41that can give people another tool to manage their health in the meantime.
20:44So maybe it's a Band-Aid, but sometimes you just need a Band-Aid.
20:57If you want to see the sources I used for this video,
21:00check out the link in the video description.
21:02And for more Truth Complex, subscribe to Business Insider.